Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama.
Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama.
Am J Trop Med Hyg. 2023 Aug 21;109(4):740-747. doi: 10.4269/ajtmh.23-0039. Print 2023 Oct 4.
Tuberculosis remains a challenge in both rural and urban areas. Although a majority of countries display a higher burden in urban areas compared with rural areas, Panama continues to report the highest mortality rate in Central America. Urban areas, such as Panama City, report a high tuberculosis burden, whereas Panama's western region, including the provinces of Chiriquí, Bocas del Toro (both semiurban) and Ngäbe-Bugle (rural), show a lower burden. We aimed to identify highly transmitted Mycobacterium tuberculosis strains within rural and semiurban settings of Panama's western region during a 3-year period (2017, 2019, 2021). We randomly selected 87 M. tuberculosis isolates from a biobank from Panama's western region and analyzed them using allele-specific oligonucleotide polymerase chain reaction and 24-mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR). Our results show only 11.7% (10/85) of M. tuberculosis strains identified as prevalent A-Beijing, B-Haarlem, or C-LAM Strains. We found a low prevalence of A, B, and C M. tuberculosis strains in both rural and semirural settings compared with isolates collected from the Eastern Colon Province. MIRU-VNTR genotyping revealed a high degree of diversity with no clusters with single loci variation of ≥ 2 loci. These results support the notion that tuberculosis prevalence in the rural and semiurban western region of Panama are not due to previously described highly transmitted strains but is influenced instead by other health determinants, including poor health system access and a lack of systematic transmission chain monitoring. For remote rural and semiurban settings, we recommend allocating resources to reinforce efforts to prevent tuberculosis spread.
结核病在农村和城市地区都是一个挑战。尽管大多数国家的城市地区比农村地区负担更重，但巴拿马继续报告中美洲最高的死亡率。像巴拿马城这样的城市地区报告结核病负担很高，而巴拿马的西部地区，包括奇里基省、博卡斯德尔托罗省（半城市）和恩加贝-布格勒省（农村），则报告结核病负担较低。我们的目的是在巴拿马西部地区的农村和半城市地区确定 3 年内（2017 年、2019 年和 2021 年）高度传播的结核分枝杆菌菌株。我们从巴拿马西部地区的生物库中随机选择了 87 株结核分枝杆菌分离株，使用等位基因特异性寡核苷酸聚合酶链反应和 24 个分枝杆菌插入重复单位-可变数串联重复（MIRU-VNTR）对其进行分析。我们的结果显示，仅 11.7%（10/85）的结核分枝杆菌菌株被鉴定为流行的 A-Beijing、B-Haarlem 或 C-LAM 菌株。我们发现，与从东科隆省收集的分离株相比，农村和半农村地区 A、B 和 C 结核分枝杆菌菌株的流行率较低。MIRU-VNTR 基因分型显示高度多样性，没有单一基因座变异≥2 个基因座的聚类。这些结果支持这样一种观点，即巴拿马西部农村和半农村地区的结核病流行率不是由于以前描述的高传播菌株引起的，而是受到其他健康决定因素的影响，包括获得卫生系统的机会差和缺乏系统的传播链监测。对于偏远的农村和半农村地区，我们建议分配资源加强预防结核病传播的工作。
